| NPI | 1487662318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AR P916021) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AR M4804036) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2021-05-03 |